Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 374-27 | WI |
NPI | 1003125683 |
---|---|
Provider Name | Diane Marie Marotz |
First Address | Sheboygan, WI 53081 |
Second Address | Sheboygan, WI 53081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 26/10/2011 |